The State

Medical School Survey Assailed

Some campuses make the questionnaire a condition of graduation. Its legality is disputed.

Prompted by a former medical student's complaint, the public interest group Public Citizen on Tuesday urged the federal government to investigate what it described as the coercive and possibly illegal practice by many American medical schools of compelling their students to complete a national research survey before graduation.

Some schools, including UCLA, warn students that their medical degrees or other benefits, including graduation tickets, will be withheld if they do not complete the lengthy survey. The questionnaire includes such sensitive topics as whether a student has been sexually or otherwise harassed while at school, and how much debt they may have incurred.

Known to generations of medical students as the "Graduation Questionnaire," the survey is written and analyzed each year by the Assn. of American Medical Colleges, a nonprofit organization that includes the nation's 126 accredited medical schools. It is administered by the schools, which use various means to persuade students to complete it. In some cases, schools give incentives to the graduating class, and in some schools, the process is voluntary.

The data are used for various purposes. They help policymakers assess the overall state of medical education in the United States and track national rates of medical student indebtedness. The information also assists medical schools in comparing their programs and student experiences with others across the country.

Dr. Peter Lurie, deputy director of Public Citizen's Health Research Group, said the survey is "a valuable tool." "But we want to ensure that it's being administered and used in a way that's consistent with ethical and legal standards," he said.

Lurie and Dr. Josh Rising, a former Boston University medical student who brought the issue to the organization's attention, said they have several concerns: that many schools use coercive measures to convince students to participate; that students are not told their responses may be published in journal articles based on the survey results; and that the practice amounts to research involving human subjects, which by law requires informed consent and a formal review by an ethics panel.

Dr. Jordan Cohen, president of the Assn. of American Medical Colleges, largely dismissed Public Citizen's allegations, saying the survey's primary purpose is to help improve the quality of medical schools nationwide.

"It's a total misunderstanding of the nature and purpose of the questionnaire," Cohen said. He said the survey was used as "an evaluation tool for these schools; it has nothing to do with research at the schools."

Cohen, whose association does use the data collected for research articles, said it is used in an aggregated way and that individual respondents could never be identified. Although in such cases there is no requirement that an ethics panel review the research, Cohen said his organization has voluntarily decided to submit the questionnaire for review in the interest of being as careful as possible.

Cohen said he did not know of schools compelling students to complete the survey as a graduation requirement but said such a requirement would be understandable.

"It speaks to the value that medical schools find in this questionnaire," he said.

In its letter to the Office for Human Research Protections at the U.S. Department of Health and Human Services, Public Citizen said 13 of the 23 medical schools it contacted penalize students who refuse to complete the survey.

Seven, including UCLA, withhold the diploma of any student who refuses to comply, the group said. Six others impose other penalties, including withholding invitations for family and friends to attend graduation ceremonies, the group's letter stated.